Representative Jake Auchincloss Unveils H.R. 6609 to Empower Pharmacists in Medicare

A recent legislative development has emerged as Representative Jake Auchincloss introduced H.R. 6609, known as the Pharmacists Fight Back in Medicare and Medicaid Act. This legislation aims to reform the operations of pharmacy benefit managers (PBMs) within both Medicare and Medicaid programs.

Key Provisions of H.R. 6609

H.R. 6609 proposes several significant changes with a focus on ensuring equitable practices in the pharmaceutical sector.

1. Medicare Regulations

• Pharmacy Payment Compliance: PBMs must ensure payments to pharmacies meet national average drug acquisition costs.
• Dispensing Fees: Pharmacies will receive a dispensing fee based on state Medicaid standards, without additional patient costs.
• Prohibition of Steering: PBMs cannot direct patients to specific pharmacies associated with them.
• Rebate Pass-Through: Manufacturer rebates received by PBMs must reduce patients’ copayments at the point of sale.
• Annual Reporting: PBMs must report compliance to the Secretary on an annual basis.

2. Medicaid Rules

• Payment Standards: Similar requirements for payment standards will be implemented for outpatient drugs.
• Steering Restrictions: Just like in Medicare, PBMs cannot steer patients to specific pharmacies.

3. Enhanced Transparency

• Public Access to Pricing: States will be mandated to publicly disclose drug acquisition prices.
• Pharmacy Reporting: Pharmacies will have to provide financial data linked to state surveys.

4. Penalties for Non-Compliance

The bill introduces both civil and criminal penalties for PBMs failing to meet the established standards. Serious violations could lead to fines or imprisonment.

5. Implementation Timeline

The majority of H.R. 6609’s provisions are expected to take effect on January 1, 2027. This timeline allows industry participants to prepare for the forthcoming regulations.

Impact on Industry Stakeholders

Key companies in the pharmaceutical sector will need to adjust their practices accordingly. Notable organizations affected include:

• CVS: As a pharmacy benefit manager, CVS may face significant operational changes.
• ANTM: This managed care organization must align with the new PBM regulations.
• ELAN: Involved in pharmaceutical management, this entity is also likely to be impacted.

Conclusion

Representative Jake Auchincloss is committed to improving the pharmacy sector through legislation like H.R. 6609. The bill reflects a comprehensive approach to reforming PBM practices in Medicare and Medicaid, aimed at benefiting both pharmacists and patients alike.